With the imposition of euthanasia upon medical practice in Canada and elsewhere, the internal logic of medicine itself – as a healing science built upon a 2500-year-old community of values – has been ignored and trampled. But in psychiatry, this aggressive vandalism is still more evident. The prevention of suicide is a principal goal of psychiatric treatment, a fundamental ethos. How can psychiatrists now be asked to validate and promote suicide? If the business of clinical psychiatry is not to produce a more satisfying relation to the experience of life, as reflected in the strength of an individual's desire to live (and to help find a path to a better future), then what is it for?

In Soviet Russia, political dissidents were often treated as psychiatric patients, on the grounds that their "irrationality" was demonstrated by their inability to understand the truth of Soviet doctrine. Once psychiatric diagnosis is subordinated to ideology, anything is possible...

WHEN I began working as a doctor early in the 1970s, end-of-life care was in its infancy. Cicely Saunders had just begun her pioneering work on what she called "total pain" and very few clinicians knew how to alleviate pain and distress in the dying. Today the situation is transformed. Palliative care has been recognised as a clinical speciality in Britain for 30 years; indeed, the country was ranked in first place in The Economist Intelligence Unit's Quality of Death index. For most people in Britain today, dying does not mean an agonising death, but a gentle ebbing away of life.

Why, then, as medical science has made enormous strides in alleviating the pain and distress of dying, are we seeing relentless campaigning for the legalisation of what is being euphemistically called "assisted dying"...